HomeMy WebLinkAboutBoyle (2) eil*OFPLAr144
• Town Hall, 53095 Main Road
ems® c ��' P.O. Box 1179
vim.°' Southold, New York 11971
JUDITH T.TERRY ®� � �' FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 996-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BOYLE, EDWARD F.
Mailing Address 1 815 HUMMEL AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 815 HUMMEL AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1404
Tax Map No. section 63.00 block 2 lot 22.000
Cross Street BOISSEAU AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/31/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
so Of
OFFICE OF THE TOWN CLERK sOFf/A—
Town of Southold
� -z. OG' Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road . 77 Residential
P. O. Box 1179 cnt'k
,� =•
Non-Residential
Southold, New York 11971 O ® �0� /Telephone ( `j► ''
(516) 765-1801
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE / A0/11
OWNER NAME: d�r�r igoy/e
OWNER MAILING ADDRESS: /LC /7/4, 1 ,.tee /4✓�
.Lho /d/ /4 i- //�`7/
OWNER PROPERTY ADDRESS: SQ rr?
OWNER TELEPHONE NUMBER: y[�
TAX MAP NO. : Section (0 3 Block g- Lot c
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ->
Residential Non-Residential/
DATE OF PREVIOUS PUMP-OUT: / /V/SV
LOCATION MAP: Must be attached hereto before permit/ may be issued.
(Locate building and system; give north arrow and feet
• of distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY:
own Clerk's Office
• DATE: / 7-567(6/
66/S
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